What Clean Claim Rate Should a Dermatology Billing Partner Actually Guarantee You?

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Choosing a dermatology billing partner based only on a promised clean claim rate can be misleading. A billing company may tell you that it maintains a 95%, 97%, or even 99% clean claim rate. But before accepting that number, you need to know how the rate is measured, what claims are included, and whether those clean claims are actually being paid correctly . For dermatology practices, this matters because a claim can pass an initial billing check and still face problems related to medical necessity, modifiers, procedure coding, payer policies, or underpayment. A clean claim rate should therefore be viewed as one part of the revenue cycle, not the entire performance picture. What Clean Claim Rate Should a Dermatology Billing Partner Guarantee? A reasonable contract target is 97% or higher , provided the billing partner clearly defines the metric and measures it consistently at the payer level. The percentage itself, however, is only part of the agreement. A dermatology practice should a...
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The Struggle of Primary Care Physicians with Dynamic Medical Billing Rules

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Medical Billing a Challenge for Struggling Primary Care Practices

Medical billing is a complex process and it’s always been a reason for the struggle of primary care physicians. In addition, their practice is often overwhelmed with constantly changing information, including protocols and billing codes which makes the situation more challenging.

When the covid-19 pandemic strains the U.S. healthcare system, primary care physicians were working to educate their patients, employ safety protocols, and handle large volumes of calls. This large volume of calls is creating administrative hurdles and operational challenges. Hence in response, many primary care practices are making changes to their medical billing processes to accommodate new patient needs.

The recent release of the Medicare physician fee schedule final rule from the Centers for Medicare & Medicaid Services (CMS) contains new hope for struggling primary care physicians and you will get to know about it in the following brief.

Add-on Code G2211

The CMS feels the need to compensate physicians and other qualified healthcare professionals for the inherent complexity of primary care and other office visits hence CMS is moving forward with add-on code G2211.

You may separately list this add-on code in addition to office/outpatient (E/M) visits for new or established patients (i.e. codes 99202-99215). Also, you can use this code even when the E/M visit is done via telehealth as this code is permanently added to the Medicare telehealth list by CMS. One important point you need to consider here is the code’s Medicare payment allowance will be approximately $15.88, but will vary geographically.

To know more about the struggle of primary care physicians with dynamic billing rules and examples that can help you to understand, click here: https://bit.ly/3ruoVyY Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

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